A Comparison of Iron and Folate with Folate Alone in Hematologic Recovery of Children Treated for Acute Malaria

Abstract

Abstract. Concern has been raised that iron supplementation for treatment of acute malaria may worsen the severity of malaria. We compared the effect of iron and folate with folate alone on hematologic recovery in children treated for acute malaria. We randomized 82 children 6-60 months of age from Nigeria with smear-positive malaria and anemia (hematocrit < 33%) to receive iron (2 mg/kg/day) plus folate (5 mg/day) or folate alone in addition to antimalarial drugs. The mean ± SD hematocrit at baseline was 28.5% ± 2.9%. At four weeks, the mean hematocrit increased by 2.5% ± 1.6% in the iron plus folate group and by 1.4% ± 1.0% in the folate alone group ( P = 0.001). Baseline hematocrit, iron supplementation, weight for height, and weekly meat intake were significant predictors of final hematocrit. The effect of iron was not significantly modified by baseline hematocrit, weekly meat intake, nutritional status, mother's education, sex, or age of the child. Iron supplementation improved hematologic recovery in children with malarial anemia.

ZIPCO, a putative metal ion transporter, is crucial for Plasmodium liver‐stage development

“…Iron availability is known to influence the clinical expression of malaria infection. Many clinical trials have concluded that iron deficiency decreased susceptibility to malaria while iron supplementation increased blood‐stage parasitaemia and disease pathology (Murray et al , ; Kabyemela et al , ; Gara et al , ). In particular, a large study in Pemba on over 24,000 children demonstrated that prophylactic supplementation with iron and folic acid in a population with high rates of malaria resulted in an increased frequency of severe disease and death (Sazawal et al , ; Prentice et al , ).…”

Effect of artemether on hematological parameters of healthy and uninfected adult Wistar rats

“…Anemia has been identified as the commonest of them all. It also forms a common presenting feature of malaria and tends to worsen it [1][2][3][4] .…”

Anti-disease Therapy for Malaria - ‘Resistance Proof’?

“…A recent study suggests that blood-stage parasites actually upregulate host hepcidin expression to divert available iron from competitor liver stage parasites and prevent a superinfection that would threaten their own niche [62]. Iron supplementation in malaria endemic regions was found to prevent severe anaemia episodes in about 30% of cases, corresponding to the average prevalence of iron deficiency [65], and such supplementation improved anaemia synergistically with anti-malarial treatment in several studies, with the synergistic effect being dependent on the efficacy of the antimalarial drug [66,67]. Iron supplementation in malaria endemic regions was found to prevent severe anaemia episodes in about 30% of cases, corresponding to the average prevalence of iron deficiency [65], and such supplementation improved anaemia synergistically with anti-malarial treatment in several studies, with the synergistic effect being dependent on the efficacy of the antimalarial drug [66,67].…”